Streeting's plan might get the NHS off its knees, but it needs more to get fully back on its feet
(Justin Kase zsixz / Alamy)
3 min read
A year ago, the government inherited our NHS in its worst state ever. Patients needlessly dying in ambulance queues, widespread failure to provide adequate and timely access to GPs, diagnostics, treatment, mental health support and basic dentistry existed alongside a crisis in social care and pharmacy too.
Our NHS was on its knees. Staff morale was on the floor. Perpetually re-announced new hospital building programmes were promised with fanfare but remained unfunded. Long-promised support for social care and better integration with health systems went unfulfilled.
Restoration of our NHS would not only require a substantial cash injection to make up for years of under-investment, but would also need a bold new plan to rebuild services and staff morale. The promise of a new 10-Year Plan to build on Lord Darzi’s excellent report last summer was encouraging. The “three shifts” were all logical and unarguable – after all, who would propose to shift “from prevention to ill health”?
The government’s recently published 10-Year Plan has helpfully set out much of the missing detail. The shift “from hospital to community” is, of course, not a new aspiration. For decades, senior health managers have sought to limit inpatient acute hospital stays, avoid admission and improve early discharge.
Twenty years ago, the NHS Confederation published its own treatise, Why we need fewer hospital beds, but many hospitals have been left with massive, unsustainably high bed occupancy levels, which often disrupts systems and compromises patient safety.
Managing the transition from where we are now to where the government hopes to be to deliver a better NHS will be challenging. I wish the government well and will be urging ministers to take account of a number of factors, including resolving the crisis in emergency departments (EDs).
Wes Streeting should listen to the warnings of the Royal College of Emergency Medicine. The government cannot take resources from our acute hospitals until it has first stabilised the management of EDs. President of the Royal College Dr Adrian Boyle is pressing for more acute hospital beds to enable EDs to move patients into admission suites, and to avoid the prevalence of ‘corridor care’ and ambulances queueing down the road until they can be safely admitted. We must stabilise the acute sector before going full throttle on the shift from hospital to community.
We also need safe staffing. Without the soon to be revised Workforce Plan, it’s difficult to see how services can be safely planned and delivered. Establishing safe staffing standards – including mandatory minimum levels of registered clinicians (nurses and doctors to patients) – is not only essential for patient safety, but has a significant beneficial impact on improved recruitment and staff retention.
Public procurement also needs to be massively overhauled. Having worked in the charitable and community sectors, I’m staggered at the poor value for money public sector bodies like the NHS get from their capital building projects. A community interest company in Helston, in my west Cornwall constituency, recently delivered an excellent GP health centre at less than a quarter of the price paid by the NHS for similar projects.
To effectively deliver the shift from hospital to community, of course, the government must fix social care. But the Casey Review won’t report for another three years. This will be used as an excuse not to drive the changes necessary. And the effective abolition of HealthWatch will cut off vital communication and patient feedback, which is important in encouraging positive change. Offering a duty of candour should apply equally to senior NHS managers and top executives, as patient safety is more often compromised by inadequate registered professional staffing levels than anything else.
Andrew George is the Liberal Democrat MP for St Ives
